Your EMR may offer you a “helpful” allergy warning when ordering a carbapenem because your patient is allergic to penicillins or cephalosporins; the cross reactivity is very low and most people tolerate carbapenems with a low risk of allergic reaction.
Add anti-MRSA only for a real risk factor — it is not routine in CAP. Risks: prior MRSA (infection, colonization, or positive nasal PCR); hospitalization or IV antibiotics ≤90 days; severe, necrotizing, or cavitary pneumonia; empyema; recent influenza; ESRD/dialysis; injection drug use. Negative nasal PCR (NPV ~95–99%) → reasonable to withhold or stop.
VancomycinMRSA
???
Monitor: target AUC/MIC 400–600; check a level before the 4th dose.
Your EMR may offer you a “helpful” allergy warning when ordering a carbapenem because your patient is allergic to penicillins or cephalosporins; the cross reactivity is very low and most people tolerate carbapenems with a low risk of allergic reaction.
Add anti-MRSA only for a real risk factor — it is not routine in CAP. Risks: prior MRSA (infection, colonization, or positive nasal PCR); hospitalization or IV antibiotics ≤90 days; severe, necrotizing, or cavitary pneumonia; empyema; recent influenza; ESRD/dialysis; injection drug use. Negative nasal PCR (NPV ~95–99%) → reasonable to withhold or stop.
VancomycinMRSA
???
Monitor: target AUC/MIC 400–600; check a level before the 4th dose.